Manual therapy
All physiotherapists at Diane Lee & Associates have taken special post-graduate training in manual & manipulative therapy and use manual techniques in treatment. Further information on the certification program for this training in Canada can be found at www.manippt.org.
Manual therapy is a term that applies to any technique that involves the therapist's hands and is often used to restore mobility to a joint, muscle or nerve as well as to relax, or activate, muscles. Many different manual techniques are used, often in combination, to help your body begin to move more efficiently. 'Releasing old holding habits' is often the first thing we do to help not only relieve your pain, but to create a new awareness of how it feels to both 'live in' and 'use' your body differently. Manual therapy techniques, combined with dry needling and self-releasing exercises, which may or may not include the use of balls or foam rollers, are the tools we use to release your tight, restricted body.
Dry Needling
Most of the physiotherapists at Diane Lee & Associates are certified to use dry needling - an effective treatment technique for myofascial trigger points and relaxation of taut muscular bands.
Dry needling, is used for muscles that are tight, and limiting motion, due to an increase in their resting tone (hypertonic muscles vs. stiff muscles). Tightness and tone are two different problems and need to be treated differently. Hypertonic muscles (muscles with increased tone) do not usually respond to stretching exercises (although some temporary relief may be gained), whereas tight muscles do. When the acupuncture needle is inserted into the tender, trigger point within the hypertonic muscle, a local (and often strong) twitch of the muscle occurs followed by an immediate relaxation of the muscle that typically restores the underlying joint's mobility. Stretching and self-release exercises can now maintain the release gained by dry needling. Dry needling is often used in combination with manual therapy and self-release exercises to 'release your old holding habits' particularly when the habit is a stubborn one!
Acupuncture
Some of the physiotherapists at Diane Lee & Associates are certified practitioners of acupuncture. Further information on the certification program for this training in Canada can be found at The Acupuncture of Foundation of Canada Institute: www.afcinstitute.com.
Acupuncture is a therapeutic method used to encourage natural healing, reduce or relieve pain and improve function of affected areas of the body. Unlike IMS, where needles are inserted directly into the muscle, Acupuncture involves the insertion of very fine needles through the skin and tissues at specific points on the body. There is no injection of any substance and the treatment itself causes minimal discomfort. "Anatomical" acupuncture refers to a more modern approach taken today by the Acupuncture Foundation of Canada Institute (AFCI). When combined with knowledge of anatomy, physiology and pathophysiology, therapists can use acupuncture effectively to treat a variety of painful disorders, both acute and chronic.
Acupuncture can be used as the only form of therapy or it may be combined successfully with other forms of medical or physical therapy. The number of treatments will vary with each individual and the condition being treated. In some cases, only a few treatments may be required. For complex or longstanding conditions, one or two treatments a week for several weeks may be recommended with less frequent treatment as improvement occurs. A correct diagnosis via an initial Physiotherapy visit is important before any decisions are made regarding therapy. Once the diagnosis is established, a qualified practitioner can advise whether acupuncture is appropriate.
Movement training & exercise instruction
"Are there any exercises that can help me?" "Are there any exercises, or things I shouldn't do?"
These are two of the most common questions we hear and are difficult to answer simply. The short answer is yes and no to both!
Recent research has changed the way exercises are used for both rehabilitation as well as strength and conditioning. For all areas of the body, the evidence supports correcting problems associated with how you use your muscles in a coordinated manner (e.g. ensuring that there is proper sequencing of muscle activation and then synergy of muscle contraction during a squat to train all the relevant muscles of your leg) rather than initially focusing exercises for strength and power of individual muscles (e.g. doing individual exercises for your quads (leg extensions) and hamstrings (bent knee curls)).
Individuals who go mindlessly through a routine of exercises (such as, if they are distracted by blasting music) will have limited success in retraining how their brain uses the muscles (motor patterns) and may get worse with exercise if poor patterns are reinforced. This may result in irritation of structures and worsening of symptoms. The problem may not be the exercise that was done, but rather how the exercise was performed. Think of it this way - if you always do what you've always done, then you'll always get what you've always got!
The key to correcting dysfunctional patterns of muscle activation is to integrate 'mindfulness' or awareness of movement during the task and to make the task functional; this is often harder on the brain than the body! We use imagery extensively to help you internalize, or 'feel', and become aware that there is a difference in the effort required to move/support your body when you use your muscle system properly.
What tells your muscles how to behave (i.e. when to contract, how much, when to relax etc)? The nervous system does. Understanding your brain and knowing what to 'think about' rather than 'do' will help to change your pain, posture and movement patterns, and really quickly too. If you are interested in reading more about this topic, we would highly recommend the following books:
- The Brain that Changes Itself by Norman Doidge
- Mindsight by Daniel Seigel
Click on the tab Education/Books - recommended reading to be taken to our Amazon affiliate page for a quick link to these books as well as more suggestions for helpful reading.
Once you have new ways to think about, and perform, your meaningful task (sit, stand, walk, run, cycle, triangle pose, sleep), you can begin to consolidate those brain patterns with more traditional training. We collaborate with many personal trainers and exercise facilities in the South Surrey/White Rock area and are happy to refer you to an appropriate trainer for ongoing exercise instruction when you are ready to take on more.
Ultrasound Imaging
In addition to its role in assessment, ultrasound imaging is useful as a biofeedback tool for 'rewiring the brain' or re-educating the proper timing of muscle contraction during both individual exercises and meaningful task training. It is particularly useful for the muscles of the trunk, or core and the pelvic floor.
Restoring the optimal sequence and pattern of activation of the core muscles (i.e. which muscle contracts when and with which) is called core training and differs dramatically from core strengthening in that you cannot strengthen a muscle that your brain is not using! See Education/Articles/Core training vs. strengthening. What is the difference and why it matters for more on this topic.
Core training will teach you how to correct the pattern of activation such that the right muscles work at the right time; following this, you can then progress to more traditional exercises for core strengthening (gym ball work, bosu, arm loading tasks etc). Recent research has shown that in as little as 30 proper repetitions, your brain begins to remember the optimal way to use the muscles. Without this training piece, your brain often continues to use the old faulty patterns that got you into trouble in the first place.
Remember - training comes before strengthening; get it right first and then reinforce the pattern; ultrasound imaging can expedite your learning curve.
Physiotherapy & Yoga
Sometimes, old movement and posture habits are easy to release and change during your treatment session, but then they keep coming back.
The story goes something like this: you tell us, "I felt better for a few days after our last session, but I can't seem to keep feeling better. The muscles tighten up and I feel the same again." Frustration mounts for both you and your physiotherapist as your brain holds onto its old way of using your body. Let's face it; old habits are tough to break.
Sometimes, all that is needed to hang onto new habits for posture and movement is a short-term coach and a few sessions of movement training to really change your brain. We have a very special movement educator, Leanne Kitteridge - a certified Anusara Yoga instructor, and a very special program (Physiotherapy & Yoga) intended just for this.
At Diane Lee & Associates, this unique program combines the knowledge and skills of physiotherapy with those of therapeutic Anusara Yoga. Therapeutic Anusara Yoga focus on your needs and does not follow poses typically found in a Yoga class. Your physiotherapist will collaborate with Leanne to ensure that your movement program and home practice fits your needs. This time is all about 'feeling your body' and not just 'understanding the ideas about what needs to happen'. In these sessions with Leanne you will do all the release, align, connect and move work necessary to retrain your brain. Your homework practice will reinforce what you learn in every session and, as long as you commit to the practice, you will be amazed at how fast you will be using your body differently. She will recommend appropriate studios in the community near you when she feels you are ready to move on.
Orthotics and bracing
Diane Lee & Associates is pleased to collaborate with Noëlle Trotter of West Coast Pedorthics. Noëlle is a certified pedorthist who assesses biomechanical and structural function of the lower limb and then dispenses custom foot orthotics when necessary. Noëlle works in collaboration with the physiotherapists at Diane Lee & Associates and is in a unique position to offer an integrated approach to the prescription of foot orthotics.
Philosophy on Orthotic Therapy
The use of a custom arch support is a non-invasive way to reduce or eliminate pain in areas such as feet, ankles, knees, hips and lower back by improving structural alignment and/or restricting or enhancing motion. However, they do not take the place of any restorative exercises recommended by your physiotherapist. Orthotics can be used to treat a variety of injuries and often work best in conjunction with other therapies.
Assessment and Casting
A pedorthic assessment includes the following:
- Complete history analysis
- Alignment tests
- Range of motion testing
- Gait analysis with video camera
Foam box casting is the preferred method of casting as it is more specific than slipper casting, but slipper casting is used on occasion depending on the lab used, type of injury and type of orthotic being built.. Several different labs are used depending on the injury, foot type and the needs of the client.
Computer systems are not used in the evaluation process since none currently replace the experience of a trained professional. Computers focus on 2D image/analysis only and the foot is a complicated three-dimensional structure with many articulating joints and muscular attachments.
Orthotic Prescription
Orthotic design depends on injury, foot type, lifestyle and footwear. Rigid orthotics are not used. Instead, plastics of varying thicknesses are utilized depending on a variety of factors. A U.S. lab called 'Sole Supports' manufactures a calibrated product, which no other lab is able to duplicate. Patients report better comfort and symptom alleviation due to the ability of the lab to calibrate plastic thickness based on a person's body weight and forefoot flexibility. This lab is used most often for functional orthotics. Click on the following link to learn more about the difference between Sole Support orthotics and other orthotics on the market www.solesupports.com.
Shoes
Properly designed and fitted footwear are essential to the function of your orthotics. At the end of the assessment, recommendations for proper shoes are given. However, it is recommended that you wait until you receive the orthotics before you shop, just to ensure the most ideal fit.
Bracing
Custom bracing for either your knees or ankles is a non-invasive way of managing pain or instability for a variety of conditions. Custom products are built to your specific dimensions and injury. Knee bracing for osteoarthritis is a very effective way to manage pain, keep active and postpone surgery. We use two major brands for bracing, Ossur Generation II and Donjoy to give the best selection for leg dimensions and activity needs.
Custom knee braces for treatment of:
- Ligament insufficiency from injury or for post surgical rehab and injury prevention
- Osteoarthritis in both joint compartments or unilateral
Custom ankle bracing
RITCHIE BRACE FOR TREATMENT OF:
- Tibialis posterior tendon dysfunction
- Congential aquired flat foot
- Severe structural deformity
- Ankle trauma / ligament insufficiency
- Mild drop foot
- Degenerative ankle arthritis